Two Doctors, Two DPC Clinics, and a Renovation Funded by Historic Tax Credits | Dr. Manuel Vogt, Texas DPC

Can Direct Primary Care really pay off for a physician family carrying student loan debt and no employer match? In this episode of the My DPC Story podcast, host Dr. Maryal Concepcion talks with Dr. Manuel Vogt of Texas DPC about the real financial tools behind building a thriving practice.

From a billboard at a railroad crossing to a 220-patient pre-enrollment list on opening day, Dr. Vogt shares how he and his wife built two separate Direct Primary Care clinics in San Antonio while protecting each other's autonomy. The standout story: how they used federal and state historic preservation tax credits, ADA credits, and a solar carport credit to fund a clinic renovation, then sold the state credits for 93 cents on the dollar.

In this episode you'll learn:

• How a physician couple runs two independent DPC practices as a family
• Using historic tax credits to fund a clinic renovation
• Subleasing clinic space to cover your entire overhead
• Marketing to employers through a multi-clinic DPC umbrella
• A workaround for Texas dispensing laws and discounted wholesale labs
• Better diabetes care with CGMs and same-day texting
• Finding the panel size (around 500) that supports a daily 5K and school pickups
• A pricing strategy that raises rates without losing patients
• Advocacy priorities: in-office dispensing and FSA eligibility

Whether you are a resident exploring Direct Primary Care or an established DPC owner planning expansion, this conversation is full of practical, money-saving ideas.

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Transcript

0:05

Direct primary care is an innovative alternative path to insurance-driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return, builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the My DPC Story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Maryal Concepcion, family physician, DPC owner, and former fee-for-service doctor. I hope you enjoy today's episode and come away feeling inspired about the future of patient care, direct primary care. Renovating healthcare is challenging. We've been kind of stuck in this insurance-based model where, insurance companies also have no accountability, and it's a lot of work. It's gonna be more work than renovating my wife's clinic for sure, but it's doable, and I think DPC's leading the charge in how we can overhaul healthcare. I'm Dr. Manuel Vogt with Texas DPC, and this is my DPC story. welcome to the podcast Dr. Vogt. Thank you for having me. Pleasure. So we uh, have had a lot of action in Texas when it comes to DPC, especially with the DPC coalition trying to fight for prescription allowances for you guys to be able to dispense in the state of Texas like we do in many other states. But it's very exciting that in this month where we're talking about tools that help you, hopefully you will have a tool that will help you prescribe to patients differently, we're going to be talking about ways that your practice has benefited from financial tools that people might not be aware of or have leaned into previously. Overall What I'd really like to give as a frame for everybody listening is that really we're talking about this renovation of healthcare, and I really thought about that word over and over when I was looking up your information and information about your wife's clinic because we're taking what's existing, what worked in the past and then basically trying to piece everything together in a better way. You got your start in a place different than San Antonio, and then your wife is from San Antonio. So tell us about how you guys have come together to be a family in the direct primary care space know that journey well. My husband's my DPC partner. Um, And we also were together in residency. So tell us about your guys' history and how you came to be in the DPC community. I'm from Germany originally. Didn't speak English when I moved over kind of in the early '90s. My dad worked for a company called Bosch at the time and offered us a two-year contract. And then after two years they said we can either stay here, pursue, you know, um, longer wor- visa or a green card eventually, so that's what we did. Eventually I ended up going to college and medical school in Kentucky. I went to a DO school in Pikeville, and then did my residency in Brooklyn, New York, which is actually where I met my wife who's also a DO. She went to Kirksville. And then after three years we said, "Let's go back to Texas. It's a little bit more of a physician-friendly state." And her parents still live in San Antonio, and eventually actually my parents moved down here as well. That's awesome, looking at your guys' website you have littler kids on the age spectrum. And so it- Yeah is very, helpful to have family around, so that's awesome. Now, when it comes to your guys' journey after residency as you talk about Texas being a physician-friendly state, I'm wondering when you thought about physician friendliness, what was the, outlook on post-residency years like for you guys? Texas had passed some, very physician-friendly laws, and I think some- they did some tort reform. So and there was also no state income tax, so there were a few layers to actually why we chose Texas, but also a big thing was the family. We actually became interested in DPC during residency when I came across just the DPC Summit at the time, and we actually went I think in our second-year residency together and we said, "This is amazing." And it was much, much smaller back then. And it's amazing to see how much it's grown. We actually went to the one I think one or two years ago, and the amount of vendors and people and the interest was just phenomenal. That's fantastic, and again, I love that you got exposure in your years of training versus six, 10 years after you- Yeah training to learn about this model, so that's fantastic. And I'm wondering here because- We do have people listening who are still, finishing their residency training. What did you guys take with you, especially because you are a physician couple given that, the world of DPC is not one that has a employer matching your HSA or a 401. How did you guys think about, yes, Texas is a little bit friendlier in terms of taxes compared to somewhere like California where I am, but how did you guys envision making DPC work for you, especially financially? It's been such an interesting journey. I think we, probably make more now than we did when we were in private practice. My wife worked for a Medicare Advantage company originally. She had a lot of student loan debt because she was actually a uh, mechanical engineer first and then went to go get her master's in biomechanical. Did a year of that, didn't like it, and went back to do her pre-med and then went to med school. So we both knew we had a lot of student loan debts coming out of this so we went more of the traditional route originally. We saved up money that way eventually bought a house, built up some of our 401s, and then were able to transition, and pretty quickly we also developed like a 401program for our clinics and certain saving protocols. And in terms of making the transition to DPC, you guys have learned about it in residency. You did, time in the insurance space world but to my understanding, your wife was the one who ventured out into DPC first of the two of you. Is that correct? Correct. She started, I wanna say in probably about 2022, maybe end of 2021 while we were rebuilding, you know, her, clinic which was a property that we had purchased. And she had just given birth to our I think our daughter at the time. And so we transitioned over and she took a lot of time off and was able to spend more time with her family and with the kids that way. With her making the jump and you guys still in two separate direct primary care clinics, what was the decision or what was the conversation around should we work together? Should we have our own DPC clinics? Because that's something that I think is, great. You guys are doing your models of DPC, which is what everybody else is doing. They're doing their own models of DPC. But how did you guys make that transition work with two separate DPCs versus one? We knew we could work together. We worked together during residency in the same clinic. But she has a little bit more of a focus on women's health. And she really wanted to focus on her patients. I had more interest in also growth and expansion and having a bit of a larger patient panel. And that's kind of one reason we separated the two entities, was for her to be able to have her own clinic, run it the way she wants. I'm maybe on the backside doing some of the financials, and giving guidance that way. But in terms of the actual clinic that's really all her her baby, And when it comes to your jump in particular, you left about a year after she had departed um, is that correct? About that, yeah. And I think mine was a little bit scary 'cause at the time I co-owned a medical group and we had I wanna say four or five physicians. We had some NPs. A very decent amount of income, you know, and that was something I was also using to support her clinic as she was growing because the company she worked for before, she didn't really take any patients with her. So her growth was a little bit slower than mine. When I transitioned over, one thing I was able to do was get out of my non-soliciting contract a non-compete clause. Um, And then what we did was I had patients pre-register for my opening day. So I walked in with 220 patients and just had exponential growth over probably the next six months or so. Incredible. And when you mentioned that she didn't have too many patients come with her and you were able to negotiate out of your non-compete, did she have a non-compete clause that was affecting her opening? She did not actually. Right toward the end of her stint with a previous employer, they actually moved her primary clinic to just outside of the non-compete zone. So we got very lucky with that. Yeah, that's, definitely lucky. Um, If you are thinking about non-competes, I definitely would take a listen to an episode that came out earlier this month with Dr. Nyasha Spears because she's still in a legal battle with her non-compete. And so, I wanna ask here, because you had been at this medical group where it was a very different structure. You weren't working for a big corporation. You were in the ownership role of this medical group. How did you transition out? Because you had so many patients follow you. You didn't have a non-compete. But in terms of what, happened to the medical group once you left that, and were most of those 200 who joined you in your pre-enrollment from your, previous practice? So, we technically had, I think, a five-year contract, and we ended up saying we'd like to get out after three. Um, The other physician who was co-owner actually went and also opened up a DPC practice as well. We're still good friends and actually talked earlier today. The other doctors and NPs all kind of got absorbed into a different practice that was owned by the larger system. All the patients, all the initial patients were existing patients, and I'm... Oh, we're in 2016. Three years out, I probably still get a call a month from a previous patient who's interested in now coming on board again. That's the way it goes. It's pretty awesome. It's like- Yeah we totally had that effect of like, well, there's the initial, people who will jump right away, and then there's the people who are like, "Well I tried to do this in the insurance world, but it didn't really pan out, so I have to go back to the doctor I actually want to see." And it was interesting. I had patients who, could definitely afford a DPC rate who ended up not joining. And then I have other patients who literally budget me into their monthly spend. And as you were making this transition out of your insurance based practice to your DPC, I'm wondering how did that timeline work for you to transition? Did you do some branding? Did you do like, looking for your space while you were still very much in that non-compete time? Or how did the transition timeline work for you in particular? So originally, I leased a single room from a pain management doc just around the corner. And funny enough, there's a billboard at a railroad crossing right in that area. So when the train comes by, everybody has to stop and they look at the billboard, and I actually had that billboard for about a month and got quite a few patients that way as well. And then I pretty much started with a medical assistant just 'cause I already had so many patients coming in. Then six months into that, I found this little medical condo that's about 1,000 square feet that came up for sale just down the street, which I ended up purchasing. We ended up renovating that over the course of maybe a month or two. And I currently just have one room with my desk and exam table. And then I have three other rooms, and each one of those I actually sub-lease to other doctors or a nutritionist. One of them's a pediatric DPC doctor. One of them's a urologist who does cash pay vasectomies out of there. And the other one is a nutritionist and when you were making this transition you mentioned how your wife's clinic was undergoing renovations. So I'm wondering in terms of just the, act of renovation itself, what were you able to fast track because you had experience with your wife's clinic as well as now then, you know, 'cause a month turnaround is pretty awesome for any space. Right but I'm wondering if there's specific things that you were like, "We learned one time, so the next time we were, like, on it." Her clinic was a much bigger undertaking. So her clinic is about three blocks from our actual house. It's an old house that ended up getting rezoned commercially to a local artist. And I found out that there's certain historic tax credits that if you're in a nationally historic designated neighborhood, then at least Texas has a program where if you restore it to certain standards, then they will give you 25% of most of the cost in tax credits over a five-year period. And then the state also has a tax credit program that's about 20%. Now we don't have state tax in Texas, so what we did was we ended up selling the tax credits to larger corporations, and we got back about 93 cents on the dollar. So in the end that looked like, I'd have to take a look at the numbers. I think it was the state tax credits were equivalent to 106,000 that we got back. And then the the federal tax credits were 18,000 per year for five years. That's incredible. It is absolutely incredible. And what was the actual cost of the property to begin with? About 400, I'd say. But it's on a quarter of an acre. And as I did more research into this um, there's also ADA credits, right? So we had a ramp we had to put in the back that we got a 50% tax credit back on, and then we put solar charging car port in the back of her clinic as well, which we got even more tax credits back with. So our accountant really loved us or loves us for, all the papers we've had him do. I just think about, when, we see price tags of things, yes, in this case it's a house that you're turning into a clinic, but it's also when we see something that we're like, "Mm, I don't know if I can afford that right now," I love the creativity that you had in terms of, finding out these pieces of information. And when you did your research in terms of all of these different tax credits was your accountant the, person who was helpful in discovering these? Did you go down a massive Google, AI rabbit hole- Oh to find these? Yeah. This, this This was before AI. So I did all this research on my own, and then we actually switched accountants later on. So now we use a DPC-based or focused accountant. Jonathan Apgar is his name. But he does the same thing that we do with our monthly membership. He just charges a monthly membership versus like every time you see the accountant, they're charging you. And it's a fantastic way that we've found to take advantage of the accountant, 'cause we meet with him quite a bit with all these credits and, tax strategizing and everything. It's amazing. And I think about the Instagram reels I've seen of mansions in Texas and how much they are, and I'm like, "Oh man, this is not a California ad, clearly," because that's really affordable. But still, like those numbers are big. 400 is a big number, but you have property and it's in San Antonio, and it's three blocks away from where you actually live. So I think that, these are, things to, balance. Like what's ideal for you? Can you be creative? And not just what does it cost, do I have the money in the bank for that? I think that's a great thing. Before I forget this, I did wanna say when my wife opened up her practice, there's something that we did. So we teamed up with another local DPC called Tailored MD, and we created an umbrella group called San Antonio Direct Primary Care. So that umbrella group has three clinics my clinic, my wife's clinic, and Tailored MD, which technically has two clinics, so a total of four clinics. We use that to market to employers and say, "Hey, we have four clinics, and your patient or your employees can pick where you want to go." And that actually jump-started her a little bit I think with at least 40 patients. So we went around and marketed to local small group restaurants, breweries, physical therapy, other doctors' offices. And we have quite a few patients in that program now. This is fascinating. I think about Try DPC in the Ohio area where there's- independent DPC doctors who've come together to do something similar, and how did that process work for you? Because you're changing your name from San Antonio DPC to Texas DPC, which is definitely a greater area of coverage. And I'm wondering strategically, how did you guys, come together to be able to do this? Because sure there's other people wanting to do things like this, but, How did you guys address branding- All new stuff staffing? Yeah. So it's really we technically don't have staff under that company except for Dr. Clemens, who's Tailored MD, his wife. And it was just my wife and them kind of going around. They had a presentation and, that's pretty much it. The idea is always to keep the cost low, and that's really what we did with this, you know? and it was as simple as, I had called up Dr. Clemens at one point, and then we became friends, and then we sat down one day and said, What do you think about this idea?" And that's how it started. I think it's great, and especially when there's so many ways to be creative as to your autonomy is maintained even if you're under an umbrella. Yeah. And I think that that's- Yeah really important, especially as we're thinking about renovation of healthcare and rebuilding better, and that's one thing where if the corporation gobbles you up, not a good thing. Moving on choose an opportunity like this instead is definitely something to look into. And when it comes to the employer- experience. Mm-hmm. Is there representation of your autonomy in your employer agreements, or is there some minimum standard of this is what to expect no matter which of the four clinics or more going into the future you'll be sending your employees to? So they do have to choose a clinic to go to, but there are just some standards in place that we have. I know you were mentioning that, we're trying to change some laws in Texas where we can dispense in the office. So the way we found around that is through a company so, we've incorporated that into our employer plan, so that gives them the access to local medications and mail order medications. And then of course a lot of the, blanket testing that we do in the office, so you know, strep, flu, COVID, urine dips, things like that, of course. And of course access to super discounted labs. So with our labs, our wholesale costs, we just round it up to either the next $5 or $10 increment um, just to cover our processing fees. So their annual panel's 25 or $30 versus, what they would spend if they went to a standalone lab or somewhere else. In California we can't do pass through billing for a lab. Mm-hmm. So if the lab costs $6.36, that's exactly what the patient gets billed in our state. Definitely look at your own state's rules for your rules. But in terms of like, keeping up to date, we give an estimate and then what the actual bill is, we present that to the patient and then we bill them for that exact amount. I'm wondering do you guys periodically go through what's the updated cost of this medication or this lab? Because it was pretty incredible. I didn't realize that the CardioIQ that I order, it's like Amazon pricing. Oh. It will range between like you know a $10 difference depending on the day or the moon cycle that I am checking prices on. We use a, big lab, but it's not Quest or LabCorp, that type of level. So whenever we get pricing or we're, getting new labs like the lipoprotein, the apolipoprotein, you know, then they give us a new estimate for just that lab test and everything else stays in place. So they have yet to- Actually increase anything, on their end for us. That is amazing. I'm glad that you guys have that, for sure. And when you're looking at your practice and your space, I'm wondering, you, did your renovation that was shorter than your wife's at your condo clinic. But you have multiple physicians, nutritionists using your clinic space. I'm wondering as you think about expansion do you think about using your space for other people who are practicing under the flag of Texas DPC? Do you see yourself purchasing additional buildings, especially historical buildings? course, ideally historic, but right now we're looking at around the Helotes area in San Antonio. And we've already potentially found a 2,000 square foot building there within a very reasonable price that we're looking at. Yeah. And tell us about your thoughts on mixed use versus a space solely for your DPC. Because I think about like Lantern DPC Dr. Ben Akins' practice, he has multiple clinics, but they're all Lantern physicians and providers. And then there's other places that, you know, like I get to sublease this place, and- I'm still getting to run my own DPC out of it. We have representation in that department as well. So tell us about your own thoughts on an exclusive space for your DPC versus a mixed culture. I went with more the sublease in my space just because now it covers my entire overhead, you know, um, including insurance. It's just a regular guaranteed passive income that's coming in that way. And I found that, the relationships I've built with the ones who are subleasing the space, so like the pediatrician, I don't see young kids, so my patients ask me all the time, "Hey, do you know a pediatrician?" I'm like, "There you go," you know. And then if they grow out of her practice, then they can switch over to mine kind of. Um, Same thing for the nutritionist. So of course, in the world right now with all these GLPs I send them a ton of patients 'cause I want it to be a wh-whole approach and not just, Here's your shot." You need to actually make the lifestyle changes. And with the nutritionist, I know everybody says, "I know what to do," but when you actually sit down with the nutritionist, that's a whole 'nother story. So, I think that it absolutely calls out the reality that a lot of us are facing when we're talking with our patients, that it's not an easy fix. A GLP is a tool, but it's not a replacement for education on nutrition for sure. So I, love that call-out just on the existence of nutritionists. When it comes to your practice of medicine and how you explain, the pediatric patients, you have a great place to refer them to. your big focus of your practice is the world of diabetes for patients, and I'm wondering when it comes to the way that you were practicing in your insurance-based clinic to now, so many people, over 200 people followed you, and I'm guessing that a lot of those people had some sort of glucose intolerance or diabetes, and what was the difference in care that you were able to deliver between the two models for diabetic patients- Yeah or people with sugar intolerance? My um, social media team just posted a video that I did of a new patient today who came in I think the A1C was at least 11. But, I spent probably an hour and 15 minutes with them just walked them through everything. We put a CGM on them right there in the office, and I have so much more time now that I'm constantly on the apps looking at what their numbers are doing. So they're getting texts from me, you know, saying, "Hey," you know, adjust this" or, "Let's tweak this a little bit." Um, and there's just so much more time. It's not that 10, 15-minute rushed visit. you can actually explain things, you know, and, Here's how the glucometer works." "Here's how this Ozempic pen works." "Here are some samples of Synjardy," you know I love that you have this example from today. I think that also the time example is so typical now of a DPC patient. I was talking to somebody earlier about why patients choose DPC from the patient perspective and that I was talking to a patient and a person who wasn't a patient who was coming in and they were like, do you get that? Do you get service like this in your insurance clinic?" And it was like a very, you know, tone to that question and I was, like, watching this live time and I was like, I love that the patients get why the heck that this is a valuable model. And I'm wondering in terms of representing these stories through your social media team, how do you approach your patients to, say, especially a new patient to say, "Hey I'd love if we could, help others understand this model through a story like yours"? we've done some patient testimonials as well. I mean it's been incredible to see like,, the following. Yeah, I've had patients who live four hours away. My furthest patient right now is actually in the UK on a military base, and they were an old patient of mine who found me again six months ago and was just so frustrated with even the VA medical system or whatever he's in, that I was like, "You do understand you're in a different country, right?" He was like, "Yep, I'm okay with that." Um, But I had somebody move two or three times and just keep me on and now they're back in Texas. And it, it happens all the time that, patients will come very, very far to see us. And that said, just going back into the idea of renovation the blog accompanying this podcast will have pictures of your wife's office and a renovation. But with both of the spaces, yours as well as your wife's, also you looking into this new space, how do you envision the space helping reinforce what we're doing Because the renovation of a care space- that's a big thing for me., I was so irritated when in my old clinic, I mentioned to the CEO this And I apologize for being judgy for my Medi-Cal patients, but I literally said, This looks like a Medi-Cal clinic. Does it not look like a Medi-Cal clinic to you?" When there was, like, carpet squares that had come unglued and there's scratches on the wall and stuff. And I was like, I don't prefer to give care in a place that doesn't look like we take pride in it," is basically what I was saying with that statement. And I'm wondering how you go about- The idea of renovation, not only from, how you pick your contractors, how you pick your partners to help with the renovation, but also how you design spaces to deliver care that matches your, actual care that you're delivering to your patients. So we specifically designed both of our spaces to just throw all that out the window of what people are used to being a doctor's office. When you walk into my wife's clinic I can send you a photo of her waiting room. It's super cozy. It looks like... In Germany when, when I lived there, we had, the Hausarzt, the local family doc, and his clinic was literally in his house, you know? and we wanted to just feel comfortable and different and not stressed. We get compliments all the time that they're like, "This is not what we're used to," you know? Um, we have, at least in mine, I have two chairs in my waiting room, but none of my patients really ever wait really to see me anymore, right? And if they do, it's usually if my MA has, is doing a blood draw or something. But, it's just the whole idea is relaxing. We have some really, live plants that are really cool that are, like, hanging out on the desk. But yeah, people love it. I'm wondering if you can tell us what you guys were going through in terms of like, that's something we can, yes, we can get tax breaks on, but, that's something we could actually, do a renovation on versus we are totally walking into a money pit here. The thing is in our area of San Antonio, the, one, the inventory's super limited, let alone any commercial. And we specifically wanted, or she wanted especially, to stay around very close, especially with two young kids. So we actually, we knew the owner of that building, and we wrote them a letter with our intention and what we're doing, what DPC is, how that's gonna benefit the local artist community. And that's kind of how we put in our offer and got accepted. And it is a lot of work, I'm not gonna lie. Especially, going through- The historic preservation bits of it, because the city itself has an HDRC, Historic Design Review Commission board. That's a whole level. And they care about certain things. When you go for the tax credits, it's one step above that a bit. That's one reason why her the handicap-accessible ramp was in the back of the clinic and had to be very, very long because the step in the back was, quite a few feet high, and it's inch rise for every foot. So instead of the front where it would've been a short ramp, they said it obscured the visual presentation of the historic building So that's how we had to put it in the back. And they did such a good job on that ramp, they actually use that in their presentation now on how to do a rehabilitation for ramps. I hope they also have a picture of "This is the location. This direct primary care," wink, wink, "is where you can find it. Go take a look. Go be a patient." That's awesome. when it comes to the being new to this historical world and a renovation of tax breaks, did you find people who were like, "My, our specialty is in historical buildings"? Because I had a patient who that was his specialty. Victorian restoration was his hobby/career, and I'm wondering if there were particular people who you leaned more towards because they had historical work background. So there are contractors like that. We got very lucky. I don't even remember how we found His name's Mike. he his wife's an architect very highly regarded architect. But Mike also has a huge interest in historic preservation and how to save all the, like the shiplap and all this stuff, so it was, a good fit, and he was very hands-on, very good on the project. But I know. I've, I've heard horror stories of people getting ghosted by contractors. We've gotten ghosted by some contractors with a- another project we've done, so y- you do have to be careful and just make sure they're very well-vetted. And when it comes to financing the journey, like you mentioned how you were financing your wife's clinic in part- Mm-hmm um, as you stayed on at your insurance-based clinic. But I'm wondering- Like, what would you recommend somebody think about in terms of purchasing the property price is one thing, but how much would you suggest, if you can for the contractors, for the permit applications for historical permit-type stuff? or even just good resources that you found can help other people find out what- Mm-hmm to budget for in their state. So there are companies that specialize in this, and we used one called Post Oak Preservation. And pretty much what that involved was she's no longer with the company, but she was an architect that worked with them. So she came in, and they've done so many of these renovations that they're like, "You can do that. You can do that. You can't do that. We'll word it like this." you know, And they were just on par. But that cost was probably about 10,000. But very well worth. They do all the applications. They know exactly what, will go through and what will not. And I think especially, like you mentioned, you had a pre-enrollment of 200-plus people. Yeah. Money like that definitely helps the anxiety of how am I going to fund X, Y, or Z? So it's definitely, I, really appreciate you mentioning your wait list, even though it wasn't for your wife's clinic. But I think that, like our family, things get a little gray, 'cause it's like, well, we're married, and our money goes the same place at the end of the day anyways. But I think that, this is, these are things to definitely talk about with your accountant. Because especially in the case of your family, like our family, if you're married, if the money's going towards the same tax, return at the end of the day, and you can have tax advantages like you guys have amazingly achieved more power to you. Now um, owning your own clinic has many, many benefits, and I highly recommend it if you can do it. I wanted to go back to your journey and opening as well as growth of your clinic in particular because you mentioned you had an assistant come on with you because you had so many people in the beginning, which congratulations on that. That's amazing. How did you bring on those patients, especially because they're patients that you knew beforehand? Did you maintain your electronic health record? Did you get a new one? And how did you move people, quote unquote, from one clinic to the other because from the admin side. Because from the person side, you know these patients, you probably know them better now. But I'm wondering how did you, admin-wise transition them? My MA I had hired started before maybe a couple weeks and was already in process of requesting all the records, getting everything set up. So I left the previous office on Friday and then walked into the new office on Monday. You know, um, And it was pretty, flawless in terms of the transition with everybody and, of course, patients were, just amazed at the difference because the last clinic was run, you know, how some of these are run. it's in the insurance world- for sure. Yeah. But, I mean, one thing is, when she was off sometimes, you know, I had to do everything. So, one thing would be make sure you know how to do everything, so all the swabs, EKGs um, gotta, know it all. I'm laughing because of like, did we have to Google the user's manual for the autoclave? Yes, 100%- Right in our clinic. Like 100% know how to do things. That is a great piece of advice, for sure. And in terms of your guys' schedule, we talked about how when your wife was pregnant with your daughter and she was able to have, more time because of the transition to DPC. What's life for you guys like now in terms of your being doctors as well as your being parents? If you're not DPC, it's hard to explain how much more family time you have. Um, I take the kids to school every morning. My first patient's maybe at 8:30 or 9:00. And a lot of times I'm probably done at the clinic by 1:00. Of course, I'm, after hours or, you know, after I'm still handling some messages here and there. But it's not only good for family, but also being able to take care of yourself again. So, I was very stressed out, super high anxiety. I love to run, which was very difficult in the, you know, insurance scenario. And I think this month I've run a 5K every day. I love this though because I just had a discussion last night with my five-year-old who's the letter S in the ABC Fashion Show on Thursday at 1:30, and I'm like, thank gosh. Again, this is another reason why I'm so glad this is DPC, 'cause there's no way that I could've known about this on Monday, excuse me, Tuesday, and told my patient, "I'm sorry, I can't see you because I have to go to this thing." Like, I wouldn't have been able to get it off. Yeah. So I cannot agree with you more on that. have your kids asked you why you pick them up on time or, or- when school gets out? So mine have asked me that, they're like, "Dad, why do you always pick us up when, school gets out? Like,, All the other parents they wait till 5:00, they're in aftercare." I'm like, Cause I can and I want to spend that time with my young kids," right? You gotta enjoy it now when they're still young. Currently we're in the middle of the finale of the Harry Potter Wizards of Baking challenge. Uh-huh. And that's something that we're doing after school because right now this week my husband's gone, so technically I get to make the rules this week. But I'm like, "We're gonna do it, guys. We gotta see what the finale is." And like, yes, that's what we're doing after school, after their homework is done. But it is fun. It's not like, okay guys, I can't do anything except for give baths or showers because I literally have no more energy. Parenting was way harder when I couldn't have any time to myself in fee-for-service. going back to your panel and growth, because I specifically wanted to put this piece about your lifestyle and your wife's lifestyle in before we talked about growth because, I think about, Strategically, you had somebody helping, you knew your patients beforehand. This is fantastic. But I'm wondering, after those initial 200 how have you grown and still been able to maintain running a 5K per day and picking up the kids on time? I found that my sweet spot is right around 500 patients of what lets me live the life I want to live and still take care of my patients the way they should be able to be taken care of. And I kind of hover around that. And, originally my initial patients that came in, I was charging $100 per member, per month. That increased to, I think, 120, and then I actually increased it to 150. I didn't bump up anybody from 100 to 150. I did build in like, a certain bump but didn't lose any patients. If I did, it might have been one with that. Um, And I, you know, I, when I send that, I also remind them, "Hey, new patients are at 150, and you're still at, 120 or somewhere." And I've had patients just flat out email me back and said, "Can you just bump me up to the highest tier?" It is very cool when patients will make those types of comments- Yeah because they're like, "I don't even know how you're getting by, but, this can't be enough." And you're like, so thank you for that thought. However, if you math out the math, just like you said, you can make more in DPC and do personalized care, spend an hour plus with a person who has diabetes- Mm-hmm um, and still run your 5K. And when it comes to 2026 being different than 2025, in your state, as we're talking about, advocacy to try to get dispensing easier, even though you found a workaround, which is awesome, what other things do you see in Texas in particular? Because Texas is very DPC friendly other than the dispensing laws I would say. What else do you see in Texas that people should be thinking about if they're looking to this model? I mean, Texas is very DPC friendly. And the amount of practices that have popped up probably in the last three years has been incredible. And the other fantastic thing is the DPC community is just a whole nother level of open in terms of "Hey, what worked for you? What should I do? What EMR?" "How are you handling this?" Other DPC docs cover us. We're about to go actually to visit my family in Germany for two and a half weeks. And I don't have to pay for coverage and, we just have one of the other clinics cover us. So there is a huge community and just openness and desire to help each other succeed which I think is fantastic. It is, and it's so needed as we renovate the system of healthcare, like community of doctors who are taking care of patients. it's really fragmented in the system because we don't even have time to really, one, come together easily and two, to make changes after we've come together and brainstormed how we can do things better. Though that's not a really easy thing to achieve in the system. Yeah. I think one thing I would like to see is that they would go back and add the FSA eligibility to cover DPC memberships because it was clearly written for HSA, but FSA is still kind of a, gray area that we've found. And I definitely would say everybody who is thinking in that thread or advocacy in general, definitely check out dpcare.org for the Direct Primary Care Coalition. It's definitely where people like Dr. Fillesku, Jay Kees, and Dr. Garrison Bliss have been working for years along with a lot of other people to get things like this HSA language adjusted the bill last July. So things that matter to you, including what Dr. Voet is mentioning, the FSA, bring these up, right? These are This is a place that is literally built for this movement. And on that note, I will also say talking about ways to support each other, definitely if you have not yet, please vote in our Battle of the Support Stack. All of the different support tools that we have communication tools, billing tools, whatever legal people who are helping We're trying to find what is working best for you and where can we improve on as a community. So definitely check that out on our website at mydpcstory.com. Now when it comes to the place that you have found that you are looking to expand into- Mm-hmm are you already talking with doctors who are like um, how do I become part of the team at Texas DPC? Yeah. So I'm currently talking to another physician and we're kind of working on what some of that partial clinic ownership looks like. um, There's somebody I actually interviewed with when we first moved to Texas who's very business-oriented as well. And we've kind of come back together now planning on this expansion. So, there's a lot that kind of goes into it, especially when you're going for your first, second location, I guess, right? So in terms of having to go through contracts that's a big one. And also not cheap, fortunately. Um, But then, right, finding the space, timing how do we initiate the growth and what does that look like? Getting into marketing different advertising, SEO, you know, it's all part of it. So it all, is gonna come together hopefully. But I think it's great that you already-- expanding versus starting from ground zero 'cause a lot of that stuff is already established, which is fantastic. And I'm wondering here, in terms of the tools that you find are most helpful for you on an everyday basis to be able to expand, whether that be, the act of actually, building a new space or growing by marketing. What do you find are the most helpful tools as you look to expand? So a good network with, lawyers that you trust. We actually used one of the AI channels to actually make our initial contract with, the things we agreed on and then send that over to hopefully save some time for the lawyers. Or it wouldn't cost, hopefully cost us so much. So, and AI can document and chart for us as well, but I found that charting's so different with DPC that I'm better off usually just typing it out myself. Um, you know, And then probably confusing specialists when my note, is very brief and to the point and not sugar-coated. Oh, man. Awesome. Well, thank you so much, Dr. Vogt, for joining us today and sharing. I'm so excited for people to hear about historical taxes or taxes related to historical buildings and just this journey that you and your wife have both had, but also how you both are in DPC as a family and have two separate DPC clinics and they're just as amazing as all of the others out there. So thank you so much for coming on and sharing today. Thank you so much for having me. Thank you for joining us for another episode of My DPC Story, highlighting the physician experience in the world of direct primary care. I hope you found today's conversation insightful and inspiring. If you want to dive deeper into the direct primary care movement, consider joining our My DPC Story Patreon community. Here, you'll have access to exclusive content, including more interview topics and much more. Don't forget to subscribe to My DPC Story on your podcast feed and follow us on social media as well. If you're able, I'd greatly appreciate if you could leave us a review. It helps others to find the podcast. Until next time, stay informed, stay healthy, and keep advocating for DPC. Until next week, this is Maryal Concepcion